比较YEARS方案和简化Wells联合方案在可疑急性肺栓塞患者评估中的价值  

Comparison of the values of the YEARS algorithm and the simplified Wells combined with age-adjusted D-dimer algorithm in the evaluation of patients with suspected acute pulmonary embolism

作　　者：王浙桦 周宏斌[2] 袁东 李刚[3] 李亚清[3] Wang Zhehua;Zhou Hongbin;Yuan Dong;Li Gang;Li Yaqing(Zhejiang Hospital,Hangzhou 310030,China;Department of Respiratory Medicine,Zhejiang Provincial People's Hospital(Peopled Hospital of Hangzhou Medical College),Hangzhou 310014,China;Department of Emergency Medicine,Zhejiang Provincial People's Hospital(People's Hospital of Hangzhou Medical College),Hangzhou 310014,China)

机构地区：[1]浙江医院,杭州310030 [2]浙江省人民医院杭州医学院附属人民医院呼吸内科,杭州310014 [3]浙江省人民医院杭州医学院附属人民医院急诊科,杭州310014

出　　处：《中华结核和呼吸杂志》2020年第12期1055-1060,共6页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：国家自然科学基金项目(81870028);浙江省卫生高层次创新人才培养工程(A-2017-CXCR02)。

摘　　要：目的比较YEARS方案和简化Wells联合年龄调整D-二聚体(sWells-Age)方案在可疑急性肺栓塞患者评估中的价值。方法纳入2016至2017年浙江省人民医院行CT肺动脉造影(CTPA)检查的可疑急性肺栓塞患者285例,其中男155例,女130例,年龄18~89岁,中位年龄66岁。以CTPA为诊断标准,比较两种方案在总体以及按照院内/院外起病进行亚组分层后的患者中评估的差异。结果285例中80例患者经CTPA确诊急性肺栓塞(80/285,28.1%),两种方案的诊断一致性好(κ值为0.855,P<0.05)。YEARS方案有效性为21.8%,sWells-Age方案有效性为17.2%,失败率分别为1.6%和0.0%,特异度分别为29.8%和23.9%(P<0.05),敏感度分别为98.8%和100.0%。在不同起病地点(院内、院外)的亚组分析中发现:院外起病患者YEARS方案和sWells-Age方案的有效性分别为33.0%和26.9%,特异度分别为44.7%和37.1%(P<0.05);院内起病患者YEARS方案和sWells-Age方案的有效性分别为1.9%和0.0%,特异度分别为2.7%和0.0%。结论两种方案的诊断一致性好,失败率低,均可安全地排除可疑急性肺栓塞患者。YEARS方案较sWells-Age方案可安全地排除更多的可疑急性肺栓塞患者,尤其是院外起病的患者。但两种方案对院内起病的患者均不适用。Objective To compare the values of the YEARS algorithm and the simplified Wells combined with age-adjusted D-dimer(sWells-Age)algorithm in the evaluation of patients with suspected acute pulmonary embolism(APE).Methods Patients with suspected APE receiving CT pulmonary angiography(CTPA)were enrolled from 2016 to 2017.With CTPA results as the gold standard,we evaluated and compared the performance of the two algorithms in the whole population and in symptom-onset site(in-hospital,out-of-hospital)subgroups.Results Among the 285 patients included,APE was confirmed by CTPA in 80 patients(28.1%).The two algorithms had a high level of diagnostic agreement(κ=0.855,P<0.05).The evaluated performance of the YEARS algorithm and the sWells-Age algorithm was as follows:21.8%and 17.2%for the efficiencies;1.6%and 0.0%for the failure rates;29.8%and 23.9%for the specificities(P<0.05);98.8%and 100.0%for the sensitivities.The efficiencies and the specificities of the two algorithms differed in the subgroups divided by symptom-onset sites(in-hospital,out-of-hospital).For the patients with symptoms-onset outside the hospital,the YEARS algorithm and the sWells-Age algorithm showed efficiencies of 33.0%and 26.9%,respectively,and specificities of 44.7%and 37.1%,respectively,(P<0.05).For the patients with symptoms-onset in hospital,the YEARS algorithm and the sWells-Age algorithm showed efficiencies of 1.9%and 0.0%,respectively,and specificities of 2.7%and 0.0%,respectively.Conclusions The YEARS algorithm and the sWells-Age algorithm had a good diagnostic agreement and low failure rates and both could safely rule out APE.More patients with suspected APE could be safely excluded by the YEARS algorithm than the sWells-Age algorithm,especially in those suspected APE patients with out-of-hospital symptom-onset.However,both two algorithms were not applicable to suspected APE patients with in-hospital symptom-onset.

关 键 词：肺栓塞 YEARS 简化Wells 年龄调整 D-二聚体 

分 类 号：R737.9[医药卫生—肿瘤] R563.1[医药卫生—临床医学]